Francesc Formiga1, Rafael Moreno-Gonzalez2, David Chivite2, Sergi Yun2, Albert Ariza3, Xavier Corbella4. 1. Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fformiga@bellvitgehospital.cat. 2. Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 3. Cardiology Service, Universitary Bellvitge Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 4. Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
Abstract
BACKGROUND: Systolic blood pressure (SBP) is an acknowledged prognostic factor in patients with heart failure (HF). Admission SBP should be a risk factor for 1-year mortality even in elderly patients experiencing a first admission for HF, and this risk may persist in the oldest subset of patients. DESIGN: Methods: We reviewed the medical records of 1031 patients aged 70 years or older admitted within a 3-year period for a first episode of acute heart failure (AHF). The cohort was divided according to admission SBP values in quartiles. We analyzed all-cause mortality as a function of these admission SBP quartiles. RESULTS: Mean age was 82.2 ± 6 years; their mean admission SBP was 138.6 ± 25 mmHg. A statistically significant association was present between mortality at 30 (p < 0.0001), 90 (p < 0.0001), and 365 days (p < 0.0001) after hospital discharge and lower admission SBP quartiles. One-year mortality ranged from 14.7% for patients within the upper SBP quartile to 41.4% for those in the lowest quartile. The multivariate analysis confirmed this association (HR: 0.884; 95% CI: 0.615-0.76; p = 0.0001), which remained significant when admission SBP was evaluated as a continuous variable (HR: 0.980; 95% CI: 0.975-0.985; p = 0.0001). The association between SBP and 1-year mortality remained when the sample was divided into old (70-82 years) and "oldest-old" (>82 years) patients. CONCLUSIONS: Lower SBP at admission is an independent predictor of midterm postdischarge mortality for elderly patients experiencing a first admission for AHF.
BACKGROUND: Systolic blood pressure (SBP) is an acknowledged prognostic factor in patients with heart failure (HF). Admission SBP should be a risk factor for 1-year mortality even in elderly patients experiencing a first admission for HF, and this risk may persist in the oldest subset of patients. DESIGN: Methods: We reviewed the medical records of 1031 patients aged 70 years or older admitted within a 3-year period for a first episode of acute heart failure (AHF). The cohort was divided according to admission SBP values in quartiles. We analyzed all-cause mortality as a function of these admission SBP quartiles. RESULTS: Mean age was 82.2 ± 6 years; their mean admission SBP was 138.6 ± 25 mmHg. A statistically significant association was present between mortality at 30 (p < 0.0001), 90 (p < 0.0001), and 365 days (p < 0.0001) after hospital discharge and lower admission SBP quartiles. One-year mortality ranged from 14.7% for patients within the upper SBP quartile to 41.4% for those in the lowest quartile. The multivariate analysis confirmed this association (HR: 0.884; 95% CI: 0.615-0.76; p = 0.0001), which remained significant when admission SBP was evaluated as a continuous variable (HR: 0.980; 95% CI: 0.975-0.985; p = 0.0001). The association between SBP and 1-year mortality remained when the sample was divided into old (70-82 years) and "oldest-old" (>82 years) patients. CONCLUSIONS: Lower SBP at admission is an independent predictor of midterm postdischarge mortality for elderly patients experiencing a first admission for AHF.
Authors: Johannes Grand; Kristina Miger; Ahmad Sajadieh; Lars Køber; Christian Torp-Pedersen; Georg Ertl; José López-Sendón; Aldo Pietro Maggioni; John R Teerlink; Naoki Sato; Claudio Gimpelewicz; Marco Metra; Thomas Holbro; Olav W Nielsen Journal: J Am Heart Assoc Date: 2021-09-13 Impact factor: 5.501